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CFO’s priority bill on out-of-network emergency care killed by Senate?

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A move to prevent doctors and hospitals from balance billing insured patients who go out-of-network for emergency services and care appears dead for the session.

The Senate Banking and Insurance Committee temporarily passed the measure — SB 516 — at its meeting last week and the bill is not slated to be heard in the committee when it meets April 7.

Under Senate rules, any bill that is temporarily deferred must be considered at the next meeting or else it’s considered “abandoned.” The rules can be waived, but it requires a two-thirds vote, which is difficult to obtain.

The bill was championed by Chief Financial Officer Jeff Atwater, who issued a press release earlier this year calling the bill a “priority legislative issue for the 2015 session.”

The Florida Association of Health Plans also considered the bill a priority issue for the 2015 session. Association President and Chief Executive Officer Audrey Brown called the bill in a press release a “win for Florida consumers.”

Brown cautioned that it was early in the process to “opine” whether the bill would die and that her association continues to support it.

“Balance billing is a real problem that Florida consumers face when they, through no choice of their own, receive emergency medical care from a healthcare provider who is outside of their network and are then subject to charges for the balance of the retail charges for the emergency health services,” she said in an email.

The Senate bill would have established payment methodology for providers who don’t have contracts with insurance companies and provide emergency care to insured patients. The bill defined emergency services and care to include transportation.

The bill set reimbursement at:

  • The amount negotiated with a participating provider or a nonparticipating provider for the service, excluding any coinsurance amount or copayment imposed by a participating provider on the participant, beneficiary, or enrollee.
  • The amount calculated under the methodology generally used by the insurer to determine the reimbursement amount to a nonparticipating provider for the service, such as the usual, customary, and reasonable amount, reduced only by a coinsurance amount or copayment that applies to a participating provider.
  • The amount that would be paid under Medicare for the service, reduced only by a coinsurance amount or copayment that applies to a participating provider.

Bill sponsor state Sen. Aaron Bean told the Banking and Insurance Committee meeting last week that he wanted the bill delayed so he could continue to work on the issue with the interested parties.

He made the comments after state Sen. Bill Montford queried, only half jokingly, why “so many people” had concerns with the measure and why, after so many years, the issue hasn’t been able to be resolved.

Montford acknowledged that one of his cardiologists called him the night before the bill “which got his attention.”

Bean acknowledged that the bill faced tough opposition and that he was “trying to find a happy medium that works for the consumer, works for Florida, works for the patient,” but that he hadn’t been able to forge an agreement.

A similar–but not identical–measure, HB 681, is moving through the Florida House of Representatives

Florida Medical Association Executive Vice President Tim Stapleton said his association is aware of the underlying issue that Bean wants to address and expects the issue to resurface again next year. To that end, Stapleton said the FMA will “work with the Legislature to find a reasonable solution that does not hurt physicians.”

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